Chapter 16 - Basic First Aid and Emergency Care

Seizures

- Convulsions when electrical brain activity interrupted - result from head injuries/strokes/infections/fevers/brain tumours/epilepsy - mild to severe => violent jerking of muscles and disorientation, even loss consciousness Risks - injury form falling - stringing nearby objects Biting tongue and lips What to do - protect form injury -> keep airway open - lay in floor, protect head - after recovery position

Foreign-body airway obstruction (FBAO)

- aspiration can lead to airway obstruction High risk groups: - children - elderly - people who are not conscious and have weak coughing/swallowing reflexes as a result of paralysis or meds and so unable to keep airway clear with reflexes - at risk for aspirating vomitus/saliva/other fluids that pool in the mouth of head not turned to side to drain Partial or complete airway obstruction: - partial airway obstruction w good air exchange -> coughing strongly + good skin colour -> put in upright position -> if object not coughed up quickly call for help - partial airway obstruction w poor air exchange -> inadequate ability to breath -> cough weak + ineffective -> skin bluish -> needs immediate help - complete airway obstruction -> cannot cough,speak or breath -> will lose consciousness quickly if object not removed -> grasp at throat -> advanced med assistance, while wait performed abdominal thrusts repeatedly - after removed object if not breather it perform rescue breathing and start CPR f goes into cardiac arrest

Strokes (cerebrovascular accident, CVA)

- sudden and life threatening - req immediate med attn How - blocked vessels in brain/ruptures = blood supply to part of brain cut off - dies from lack O2 Signs and symptoms could inc: - unconscious - Confused/disorientated - slurs - drooling - Eyelids/corner mouth drooping - sudden onset severe headache - weakness/paralysis/tingling/numbness of arm/leg/side of face - change VS, esp BP/pulse What to do? - report to nurse and active EMs system - keep person lying down and watch for resp arrest until advance care arrives

Responsibilities as a nursing assistant

1. Recognise hat an emergency exists - obv skills + familiarity 2. Decide to act - calm + assess situation and env for safety 3. Check for consciousness - gently shake or if syncope call nurse and keep them lying down until nurse arrives - if does not awake when shaken need to... 4. Activate your facility's emergency response system - earlier the greatest chance of surviving (assisted living/LTC dial 911) 5. Provide appropriate care until the emergency personnel arrive - start first aid or BLS according to situation and your level of training

Unresponsive

A person who is unconscious and cannot be aroused, or conscious but not responsive when spoken to or touched

Emergency

Any condition that requires immediate medical attention to prevent a person from dying or having a permanent disability Can be result of accident if a medical condition

Basic life support (BLS)

Basic emergency care techniques, such as rescue breathing and cardiopulmonary resuscitation (CPR)

Medical emergency

Begin with slight changes (e.g. slurring first sign of stroke) Can be medical condition (heart attack/stroke) or from accident (fall) Will learn what is normal for each pat/res - someone who is usually alert can become disorientated or unresponsive MUST REPORT this kind of change to nurse

AHA guidelines BLS - CAB

C - compressions - no pulse or breathing + defibrillator A - airway - after 1 cycle 100 C open up airway B - breathing - 2 breath then cont C - if pulse but no breathing then give breath every 3 sec and check pulse every 2 mins Used for all adults and children with exclusion of infant

Heart attacks (myocardial infarction, MI)

Can occur suddenly Is life threatening - req emergency care How - blood vessels supplying myocardium blocked so cannot deliver O2 + nutrients to heart musc, which does = heart cannot pump blood effectively throughout body - if damaged area large enough Cardiac Arrest can occur (abrupt loss heart function, breathing and consciousness) Signs and symptoms - pain/tightness in chest - can extend down neck/back/arm - pale/blue/gray skin colour - excessive sweating -trouble breathing - nausea/heart-burn-like pain What to do - if observe heart attach make person lie down + raise head - call nurse/activate EMS system immediately - if cardiac arrest begin BLS

Epilepsy

Disorder characterised by chronic seizure activity

Fainting (syncope)

How - Blood supply to brain sudden dec = loose consciousness - pain/fatigue/some meds/heat/standing long time Can be early sign serious med cond, e.g. MI Signs and symptoms inc: - if about to faint may complain dizziness/loss vision - skin pale and clammy - pulse weak What to do - have persona lie down, elevate feet + lower legs OR sit down, head between knees = inc flow blood to brain - stay with person and call nurse - if loses consciousness keep airway open and monitor breathing

Basic life support

Rescue breathing - perform function of breathing Cardiopulmonary resuscitation (CPR) - combination RB and CPR to sustain breathing and circulation for a person who has gone into respiratory or cardiac arrest - cycle of 100 chest compression and 1 breathing Automated external defibrillator (AED) - automatically detects heart rhythm and delivers electrical shock to stop fast, abnormal beats and restore normal rhythm But be aware DNR BOX 16-1

Haemorrhage

Severe, uncontrolled bleeding - trauma or certain illness (e.g. gastric ulcer) - inside/outside (might not be seen until vomits blood or passes blood through rectum) - if not controlled quickly will die What to do: - call for help - use standard precautions protect blood born pathogens - apply form pressure to wound using sterile dressing until advanced help arrives - if direct pressure doesn't work raise affected body part and apply pressure to pulse point between the wound and heart

Aspiration

The accidental inhalation of foreign material (such as food, liquid or vomitus) into the airway

Pulse point

The points where the large arteries run close enough to the surface of the skin to be felt as a pulse

Disorientated

The state of being unable to answer basic questions about person, place, or time; a star of confusion

Shock

Tissues of body do not receive enough oxygen-rich blood Diff types: - Cardiogenic shock - can happen after MInas heart too weak to meet tissues needs - Hemorrhagic shock (hypovolemic) - massive blood loss - Septic shock - severe bacterial infection entire body - Anaphylactic shock - severe allergic reaction - can cause airways close up Signs inc - low BP, cont lower - pulse rapid, weak - skin cool, clammy - disorientated -Rapid breathing -keep person walk and calm - elevate feet and lower legs

Tell the nurse!

What to report when person faints - change in consciousness and how long lasted - vomited? - appearance (e.g. pale, hot, sweaty) - complaint before incidence (e.g. loss vision, nausea) - actions you took to assist person